140. What date were the recent Chairman and
Chief Executive of Barts appointed?
(Mr Crisp) I think you will find that this was an
acting Chair and Chief Executive in the interim period before
the substantive Chair and Chief Executive were appointed, so there
was a very, very substantial set of management changes.

141. You refuse to tell me who the Chairman
and Chief Executive were who resigned, for various reasons. Who
were the two Directors of Operations who resigned?
(Mr Crisp) I think they are named in here and, I am
afraid, if they are not, I do not know their names.

142. One is named in Appendix 2 and that is
the Admissions Manager. It just seems that that is the culture,
a point other colleagues have brought up, that you are very happy
to name and blame relatively junior people, yet particularly when
they use the phrase "it became a matter of corporate responsibility",
there seems to be an almost institutionalised cover-up to protect
these very senior people.
(Mr Crisp) I think that is unfair. The people who
were chosen to be named here were chosen by the National Audit
Office, not us. I can tell you the names of the two Directors
of Operations (who were on a job share) who were referred to in
this if you would like me to do that, that information is available,
and we have three Chairs and three Chief Executives over this
period within Barts and the London and we can provide you with
those names, but it was not our choice. Indeed, we would have
preferred not to see junior members of staff named here but this
is not my report.

Mr Gibb: My time is up.

Chairman

143. On that point of naming, the fact of the
matter is that these inappropriate adjustments had been made,
and this process was going on whilst these people were resigning,
and therefore I think Mr Gibb is entitled to ask for their names
if he wants to. You can either give us the names now or, if you
do not know them, you can write to us.
(Mr Crisp) I will write to you on that basis partly
because I cannot remember the chair's name.[6]

144. Mr Gibb also raised another important point
that possibly the condition of some of these patients was exacerbated
because of the way that they were treated and he wanted and we
want reassurance that they will or have all been told what went
wrong because there could be issues of compensation involved here
and if their condition was exacerbated, surely they should be
entitled to compensation? How could they receive compensation
if they do not know what happened?
(Mr Crisp) As I say, I think there are some issues
that we have still got to pick up with the trusts around that
and we will ask those questions. The point I have made is that
for the vast majority of these patients we know that is not the
case and the National Audit Office has said that is not the case.
If there are particular cases, they are for the individual trusts
to deal with because each of these cases is different.

145. Well, you have a responsibility as well.
I do not think you can just shuffle it onto the individual trusts.
(Mr Crisp) The responsibility for compensation is
with the trusts. My responsibility (which I did say I would be
exercising) is asking them whether they had identified any patients
who were in this category.

Chairman: Thank you. Mr David Rendel?

Mr Rendel

146. What would you expect trusts to do in order
to meet the 18-month waiting list target or 15 month waiting list
target or in future the six-month target if they think they are
likely to go above it?
(Mr Crisp) The first position is to tell us. If by
that you mean the immediate action, I would be expecting people
to contact their regional office and indeed pass on the information
to me and indeed for 18-month waiters we have a requirement that
it is passed on to me.

147. What can you then do?
(Mr Crisp) We centrally ask them pretty straightforward
questions about what they are doing about it and whether they
have used all the resources that they have got, how they are handling
this, how are they going to make it happen, are they using the
private sector, all that set of questions.

148. So if they have a patient who is about
to go above the 18-month target waiting time, you would expect
them, for example, to use the private sector straightaway?
(Mr Crisp) I would expect them to do two things. Firstly,
I would expect them to make sure they got that patient treated
just as soon as they could. The second thing I would expect them
to do is to explain to us

149. What does "just as soon as they could"
mean? If you tell them they can go private, presumably they can
do it tomorrow?
(Mr Crisp) They can do that anyway. Maybe they can
get it tomorrow or maybe not, but what you do know is that most
of these 18-month waiters are for people who have got some quite
specific sort of complaint. Therefore, if you have a particular
problem with a shoulder you may not be able to get it done in
the private sector tomorrow or, indeed, the patient may not be
prepared to travel the distance to get the operation done in the
private sector. It will depend on the operation as to "just
as soon as possible".

150. If a patient comes up to 17 months and
they can see they are going to go above 18 months and private
treatment is available, then you will say that that patient should
be treated at once privately?
(Mr Crisp) And that is what happens. If private treatment
is available locally, they probably do that and it does not come
to us. We get very few cases of 18-month waiters. The other question
I ask is how has this been allowed to happen?

151. If what you say happens and they can go
and have patients treated privately, that presumably means then
that the NHS is using money to treat somebody privately who has
reached the target limit rather than treating somebody who has
greater clinical need who has not?
(Mr Crisp) No. If you are wanting to pursue the question
of clinical priorities, we are clear, and we are clear because
the vast majority of the trusts do this, that you can balance
your waiting lists so you hit not only the clinical priorities
but also make sure that you deal with the long waiters. That is
the point of my second question so that when somebody tells me
they have got an 18-month waiter I am saying, "What are you
doing about that patient?" And, secondly, "Why are you
in that position?" If you are in that position, tell me how
you are employing all the good practice that Mr Gibb referred
to, for example have you got the Modernisation Agency visiting
and are you making sure that it does not happen? We do know from
the vast majority of trusts that you can run a balanced waiting
list.

152. Presumably they would not have ever got
to that position unless they reckoned that that patient was not
getting treatment this month because they have always got somebody
who has a higher priority, either because they had waited even
longer or because they were of a higher clinical priority. You
cannot get to 17 months unless you are constantly taking the decision
that there is always somebody else who has got a higher priority.
(Mr Crisp) That is the reason why they are waiting
relatively long, but more likely what has happened is they have
had a slot and for some reason it was cancelled. It may have been
cancelled on the day or something of that sort because an emergency
came in. There are very few cases where 18-month waiters have
not already had a date and, in fact, they had usually had a date
that had been cancelled because a more urgent patient came in
at the time because urgent patients take priority. But we need
get the balance right between

153. When they get to 18 months then you are
prepared to say there should be special measures taken to push
that person, if necessary, through a private hospital rather than
spending that money on what previously up to that 18-month point
should have been a priority?
(Mr Crisp) If we have got to that point then they
will doing that as part of a wider set of issues, and that is
the point of my second question. If they have got a problem with
one patient, have they got a problem with several or have they
got a problem with urgent patients? What are they doing about
that? If your point is trying to make me say that we distort our
priorities at that point for political reasons or something of
that sort, I think what we do is we say what is the problem in
this trust? Why have we got to this situation? Is it an individual
who has been overlooked? Is it an individual who through some
bad luck has been cancelled?

154. I do not see how you can possibly avoid
changing your priorities against clinical guidance if you are
to have a waiting list system of this sort. Can I move on, I do
not want to waste all my time, and can I refer you to an article
in The Sunday Telegraph this Sunday which said that at
the John Radcliffe in Oxford a few years ago patients were being
marked with an "M" to show they had a management priority
and that they were to be treated whatever happened in order to
make sure they improved the waiting list times. Firstly, can I
have your assurance that that does not happen any more?
(Mr Crisp) I do not know. I am not aware of the practice
so I would not have thought that happened. A management priority?
As opposed to a clinical priority?

155. Did you see the report in The Sunday
Telegraph?
(Mr Crisp) No.

156. That does worry me.
(Mr Crisp) I read an awful lot of newspapers but nobody
has drawn that one to my attention, I am afraid.

157. That is staggering. There was an absolutely
clear report that people were being marked with a letter M to
give them management priority above clinical priority. If that
was not drawn to your attention I hate to think how the NHS has
been managed.
(Mr Crisp) They have been running quite a lot of stories,
have they not, and I have seen some. I do not remember the particular
point, nobody drew it to my attention.

158. As far as you know, that does not happen
any more? Can I have your assurance that as far as you are concerned
there is not a trust under your control, so to speak, or your
guidance where anybody is ever given a management priority above
a clinical priority such that waiting list targets are met?
(Mr Crisp) We are very clear what we have told people
to do which is to give clinical priority. There are methods for
doing that, not least because on every operating list you have
got room for some major patients and some minor patients, and
you need to balance your operating list and you can get in lower
medical priority patients at a reasonable pace.

159. I do not know how I can follow that up,
Chairman, because it staggers me that he does not know about it
but we will leave it for a moment. In answer to Mr Steinberg you
said at one point that some people felt that they needed to cheat
and that was the unfortunate reason why this has arisen, they
could not overcome the 18-month problem unless they cheated. You
then went on to say that you do not know why they felt that. Is
that correct?
(Mr Crisp) I think I also said I can only speculate,
I have no idea.